Crohns Disease
A Short Summary of Crohn’s Disease (Inflammatory Bowel Disease)
Epidemiology
• Age of onset: 15-30 and 60-80
• Equal incidence between males and females
• Jewish>White Caucasian>African Americans>Hispanic>Asians
• Ashkenazi Jews risk is 2x that of an Israeli born Jew.
• Urban areas>Rural areas
• High socioeconomic > low socioeconomic classes
Causes
1. Immune mediated
• Pro-inflammatory>Anti-inflammatory
• T-helper cells activation through cytokines to promote fibrinogenesis +collagen production + activation of coagulation cascade
2. Genetics
• Gene mutation at CARD 15 and XBP1 abnormal protein unfolding
• AGT16L1 mutation inability to attack invasive bacteria.
3. Environmental factors
• Diet: Animal+fish+milk protein increase risk. Vegetable protein decreases risk.
• Smoking+ NSAIDS increases the risk of flares
4. Microbes
• Multiple intestinal pathogens trigger inflammatory response.
Symptoms
• The basics: Nausea, vomiting, diarrhea, abdominal pain, bleeding, appetite and weight loss, fever
• Location: Any portion of GI tract from Mouth to Anus, involving the terminal ileum with skip lesions through out.
• Morphology: Transmural lesions with cobble stone mucosa on barium swallow
• Extra intestinal manifestations: o Joint pain: Arthritis, Ankaylosing Spondylitis (CD>UC) o Fatty liver: Primary Sclerosing Chlongitis (UC>CD) o Uveitis: Blurred Vision and Photophobia o Skin: Erythema nodosum, pyoderma gangrenous
• Complications: o Small bowel obstruction: lack of bowel movements and inability to pass gas. o Fistulae formation: depending on the organ involved may not require any therapy and may require surgery. Abscesses, or collections of pus, require drainage via surgery o Malabsorption of KADE vitamins: Osteoporosis, Increased PT, Kidney stones o Colorectal Cancer: Only if CD involved the Colorectal region, otherwise cancer is rare only in long term active CD.
• Distribution: Upper GI-5%, SM 30%,
Epidemiology
• Age of onset: 15-30 and 60-80
• Equal incidence between males and females
• Jewish>White Caucasian>African Americans>Hispanic>Asians
• Ashkenazi Jews risk is 2x that of an Israeli born Jew.
• Urban areas>Rural areas
• High socioeconomic > low socioeconomic classes
Causes
1. Immune mediated
• Pro-inflammatory>Anti-inflammatory
• T-helper cells activation through cytokines to promote fibrinogenesis +collagen production + activation of coagulation cascade
2. Genetics
• Gene mutation at CARD 15 and XBP1 abnormal protein unfolding
• AGT16L1 mutation inability to attack invasive bacteria.
3. Environmental factors
• Diet: Animal+fish+milk protein increase risk. Vegetable protein decreases risk.
• Smoking+ NSAIDS increases the risk of flares
4. Microbes
• Multiple intestinal pathogens trigger inflammatory response.
Symptoms
• The basics: Nausea, vomiting, diarrhea, abdominal pain, bleeding, appetite and weight loss, fever
• Location: Any portion of GI tract from Mouth to Anus, involving the terminal ileum with skip lesions through out.
• Morphology: Transmural lesions with cobble stone mucosa on barium swallow
• Extra intestinal manifestations: o Joint pain: Arthritis, Ankaylosing Spondylitis (CD>UC) o Fatty liver: Primary Sclerosing Chlongitis (UC>CD) o Uveitis: Blurred Vision and Photophobia o Skin: Erythema nodosum, pyoderma gangrenous
• Complications: o Small bowel obstruction: lack of bowel movements and inability to pass gas. o Fistulae formation: depending on the organ involved may not require any therapy and may require surgery. Abscesses, or collections of pus, require drainage via surgery o Malabsorption of KADE vitamins: Osteoporosis, Increased PT, Kidney stones o Colorectal Cancer: Only if CD involved the Colorectal region, otherwise cancer is rare only in long term active CD.
• Distribution: Upper GI-5%, SM 30%,